ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or continue ADHD medication during pregnancy and breastfeeding is a challenge for women suffering from the condition. There aren't enough data on how exposure to ADHD for a long time could affect a foetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus don't develop neurological conditions like hearing loss or impaired vision seizures, febrile seizures or IQ impairment. The authors acknowledge that further high-quality studies are required.
Risk/Benefit Analysis
Pregnant women who take ADHD medications must weigh the advantages of taking them against potential risks to the fetus. Doctors don't have enough data to provide clear recommendations, but can provide information about risks and benefits to assist pregnant women to make informed decisions.
A study published in Molecular Psychiatry concluded that women who took ADHD medication in early pregnancy did not have a greater risk of fetal malformations or structural birth defects. Researchers conducted a massive population-based case control study to assess the frequency of structural defects that were major in infants who were born to mothers who took stimulants during pregnancy. Pediatric cardiologists, clinical geneticists and other experts reviewed the cases in order to confirm that the classification was correct and to reduce any bias.
The study of the researchers was not without its limitations. The most important issue was that they were unable to distinguish the effects of the medication from those of the disorder at hand. This limitation makes it difficult for researchers to determine whether the few associations observed between the exposed groups were due to the use of medication or confounded by co-morbidities. The researchers also did not examine long-term outcomes for the offspring.
The study did find that infants whose mothers took ADHD medications during pregnancy were at a slightly higher risk of being admitted to the neonatal intensive care unit (NICU) than those who were born without any medication or had cut back on their medications prior to or during pregnancy. This increase was caused by central nervous system disorders. The increased risk of admission was not affected by the stimulant medications used during pregnancy.
Women who used stimulant ADHD medication during pregnancy also had an increased chance of having a caesarean delivery or having a baby with low Apgar score (less than 7). These increases appear to be unrelated to the type of medication used during pregnancy.
The research suggests that the low risk associated with the use of ADHD medications during the early stages of pregnancy could be offset by the greater benefit to both mother and child of continuing treatment for the woman's condition. Physicians should talk to their patients about this issue and, if possible, help them improve coping skills which can lessen the effects of her disorder on her daily life and relationships.
Medication Interactions
Doctors are increasingly faced with the decision of whether to keep treatment or stop it during pregnancy as more women are diagnosed with ADHD. The majority of these decisions are made without any evidence that is clear and definitive either way, so physicians have to weigh their experience about their experiences, the experiences of other doctors, and what research suggests about the subject and their own judgments for each individual patient.
In particular, the issue of possible risks to the baby can be a challenge. Many of the studies on this issue are based on observational evidence rather than controlled research, and their findings are often contradictory. Furthermore, most studies restrict their analysis to live births, which can underestimate the severity of teratogenic effects that could lead to abortion or termination of the pregnancy. The study presented in the journal club addresses these issues by analyzing both the data from deceased and live births.
The conclusion is that while some studies have found that there is a positive correlation between ADHD medications and the possibility of certain birth defects, others have not found any evidence of a link and the majority of studies have a neutral or slight negative effect. In every case it is imperative to conduct a thorough evaluation of the potential risks and benefits must be performed.
For women suffering from ADHD and ADD, the decision to stop medication is difficult, if not impossible. In an article recently published in Archives of Women's Mental Health, psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can increase depression, feelings of isolation, and family conflict for those suffering from the disorder. A loss of medication may affect the ability to safely drive and to perform work-related tasks which are essential aspects of daily life for people with ADHD.
She suggests that women who are unsure whether to continue taking medication or stop due to pregnancy should educate family members, coworkers and their friends about the condition, the effects on daily functioning, and the benefits of continuing the current treatment regimen. It can also help women feel supported in her decision. Certain medications can pass through the placenta. If the patient decides to stop taking her ADHD medication while breastfeeding, it is crucial to be aware that the medication may be transferred to her infant.
Risk of Birth Defects
As the use of ADHD medications to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases as do concerns over the impact that these drugs could have on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body knowledge on this issue. Researchers used two huge data sets to study over 4.3 million pregnancy and determine whether stimulant medications caused birth defects. adult add medications discovered that although the overall risk is low, the first trimester ADHD medication use was associated with slightly higher risk of certain heart defects, such as ventriculoseptal defect.
The authors of the study did not find any association between early medication usage and other congenital anomalies like facial deformities, or club feet. The results are consistent with previous studies that have shown an increase, but not significant, in the risk of developing cardiac malformations in women who started taking ADHD medications prior to the birth of their child. adhd medications uk increased in the later part of pregnancy, when a lot of women decide to stop taking their ADHD medications.
Women who took ADHD medication in the first trimester of their pregnancies were also more likely to undergo a caesarean section, a low Apgar score after delivery and a baby that required breathing assistance at birth. However the authors of the study were unable to eliminate bias due to selection by limiting the study to women who didn't have any other medical conditions that could have contributed to the findings.
The researchers hope their research will help inform the clinical decisions of physicians who encounter pregnant women. The researchers suggest that while discussing risks and benefits are important, the choice about whether to continue or stop medication should be made according to the severity of each woman's ADHD symptoms and her requirements.
The authors also warn that while discontinuing the medications is an option, it isn't an option that is recommended due to the high rate of depression and other mental health issues for women who are expecting or recently postpartum. Further, research shows that women who stop taking their medication will have a harder time adjusting to a life without them after the baby is born.
Nursing
The responsibilities of being a new mother can be overwhelming. Women who suffer from ADHD may face a lot of challenges when they have to manage their symptoms, go to doctor appointments, prepare for the birth of their child and adjust to new routines. As such, many women decide to continue taking their ADHD medications throughout pregnancy.
The majority of stimulant drugs are absorbed through breast milk in small amounts, therefore the risk to the breastfeeding infant is minimal. However, the rate of exposure to medication by the newborn may differ based on dosage, frequency it is taken and the time of day the medication is administered. Additionally, different medications enter the baby’s system via the gastrointestinal tract or breast milk. The effect on a newborn's health is not completely understood.
Some physicians may discontinue stimulant medications during a woman's pregnancy due to the lack of research. It's a difficult choice for the mother, who must weigh the benefits of her medication against the potential risks to the foetus. As long as more information is available, GPs may inquire about pregnant patients if they have an background of ADHD or if they are planning to take medication in the perinatal stage.
A growing number of studies have proven that the majority of women are able to safely continue their ADHD medication while they are pregnant and nursing. In response, a growing number of patients are choosing to do so. They have found through consultation with their doctors, that the benefits of keeping their current medication far outweigh any possible risks.
Women who suffer from ADHD who are planning to nurse should seek advice from an expert psychiatrist prior to becoming pregnant. They should discuss their medication with their doctor as well as the pros and cons of continuing treatment. This includes non-pharmacological methods. Psychoeducation is also required to help women with ADHD recognize their symptoms and the underlying disorder and learn about treatments and to reinforce existing strategies for coping. This should involve a multidisciplinary approach, which includes the GP as well as obstetricians, psychiatry and obstetricians. Pregnancy counselling should include the discussion of a plan for management for both mother and child, and monitoring for signs of deterioration and, if necessary, adjustments to the medication regimen.